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General NPI Number Information
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NPI Number | 1073066932
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Entity Type | Organization
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Legal Business Name | MARK J SEGAL MD LLC
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 2097 HENRY TECKLENBURG DR SUITE 212W
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City | CHARLESTON
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State | SC
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Zip | 29414-5740
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Country | US
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Telephone | 843-284-8532
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Fax | 888-397-0276
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Provider Business Mailing Address
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Address Line | 5 FOREST TRAIL CT 2
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City | ISLE OF PALMS
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State | SC
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Zip | 29451-2515
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Country | US
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Telephone | 843-284-8532
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Fax | 888-397-0276
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK J SEGAL
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Credential | MD
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Telephone | 843-284-8532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 19043
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License Number State | SC
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